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Underneath the iceberg: Disordered eating affects more people than you see

There are many different types of eating disorders. In the running community alone, eating disorders can take shape in non-stereotypical ways.

As opposed to the shy, self-conscious girl who doesn't take care of her body and covers up in baggy clothes, runners have determined mindsets; willing to do whatever it takes to achieve a desired outcome and push their body to the limits. They wear spandex, short shorts, and sports bras as attire and they flaunt it because their bodies are proof of their hard work and identity as a runner.

Despite support and resources for diagnosed eating disorders, the support for eating disorder prevention tends cease once a team of performance-driven individuals lace up. Mindsets focus on pushing one's bodies, feeling the pain, and seeing the mile splits get lower and lower each week.

In general, people shy away from addressing obvious warning signs, and the term eating disorder becomes scary, dirty and sinful. Many runners deny problems and go out of their way to prove they are still running happy and healthy. There's shame and embarrassment tied to eating issues. And instead of calling a teammate's bluff to address the problem, friends and teammates turn to questioning whether or not they should also be eating less, cutting back, or dropping weight. A contagious cycle of negative thoughts and behaviors, fueling each other's disorders.

Please hear me correctly, eating disorders are NOT sinful and its nothing to be embarrassed about. But far too often, perception is mistaken as reality. If one is running, its assumed they are healthy. And the eating disorder conversations are left for people who are already at a recovery center.

But there are more people with signs and symptoms of disordered eating running around the track than there are formally diagnosed or in a recovery treatment center.

It's like the tip of the iceberg metaphor:

People with diagnosed eating disorders are the chunks of ice you see above the water. Their problems have surfaced, and they are actively seeking help. There are eating disorder support groups and resources for these people.

But that floating chunk of ice isn't' alone. Underneath the ocean's surface is a huge iceberg below it completely unseen. People stuck in this iceberg have all the same problems, issues, concerns, but since they're still running, their issues are hidden. It's a different type of eating disorder: an "un-diagnosed" or "not fully identifiable" form of disordered eating. Since they haven't surfaced above water, and these runners are not getting the eating disorder support they need.

My goal of this article is to show you how big that iceberg under the water is...

And to start the discussion to provide support and resources to the thousands who show signs and symptoms of different types of eating disorders...

And perhaps, we can actually prevent or mitigate eating disorders, instead of only treating the ones that surface.

[I've taken most of these statistics from The National Eating Disorder Association (NEDA), a non-profit organization dedicated to supporting people and families affected by eating disorders of all forms. More information about NEDA is included at the end of this article.]

1 out of every 3 female athletes in Division 1 NCAA report attitudes and symptoms defining them as "at risk" for anorexia.

Johnson, C. Powers, P.S., and Dick, R. Athletes and Eating Disorders: The National Collegiate Athletic Association Study, Int J Eat Disord 1999; 6:179.

Whether they develop a clinically significant eating disorder or not, this still means that 1 out of every 3 college female athletes need help.

....1 out of every 3 do not have a healthy mindset about food, diet, body image

...1 out of every 3 may be limiting their potential as an athlete

...that 1 out of every 3 could tip the wrong way and dive head first into a full-blown eating disorder at any moment, ending their career and forever changing the course of their life.

In weight-class and aesthetic sports disordered eating occurs at estimates up to 62% of females and 33% of males.

Sport Nutrition for Coaches by Leslie Bonci, MPH, RD, CSSD, 2009, Human Kinetics. Byrne et al. 2001; Sundot - Borgen & Torstviet 2004

Remember that 1 out of 3 I just spoke about? Now when you are looking at a weight-class or aesthetic sport (think: running, swimming, diving, gymnastics, dancing, bodybuilding, wrestling, rowing, equestrian, horse racing)..... double it for women. It's essentially 2 out of every 3. But keep looking past the women and we add in far more men than most people want to believe.

Up to 41.5% of high school female athletes participating in aesthetic sports reported disordered eating.

Jankowski, C. (2012). Associations Between Disordered Eating, Menstrual Dysfunction, and Musculoskeletal Injury Among High School Athletes. Yearbook of Sports Medicine, 2012, 394-395. doi:10.1016/j.yspm.2011.08.003

Yes, even at the young age of high school, nearly half of a female cross-country team may be internally struggling with eating.

These athletes are up to 8x more likely to get injured, and twice as likely to incur a musculoskeletal injury.

Jankowski, C. (2012). Associations Between Disordered Eating, Menstrual Dysfunction, and Musculoskeletal Injury Among High School Athletes. Yearbook of Sports Medicine, 2012, 394-395. doi:10.1016/j.yspm.2011.08.003

Look at that group of high school runners again... nearly 4 out of every 10 has a high risk of dropping out or being forced to stop running before the end of the season, all because their bodies aren't fueled and strong enough to handle the training. Considering eating disorders are a psychological concern, what do you think sitting on the sidelines with an injury will do to a high schooler's confidence and sense of self-worth? This only continues to fuel the negative mindset.

Among female college athletes surveyed, 25.5% had subclinical eating disorder symptoms.

Greenleaf, C., Petrie, T. A., Carter, J., & Reel, J. J. (2009). Female Collegiate Athletes: Prevalence of Eating Disorders and Disordered Eating Behaviors. Journal of American College Health, 57(5), 489-496. doi:10.3200/jach.57.5.489-496

And a separate study of female Division II college athletes found that 25% had disordered eating, 26% reported menstrual dysfunction, 10% had low bone mineral density, and 2.6% had all three symptoms.

Beals KA, Hill AK. The prevalence of disordered eating, menstrual dysfunction, and low bone mineral density among US collegiate

Essentially, all these female athletes have physical and mental impairments "just slightly less" than somebody with a clinically diagnosed eating disorder. But is it really fair to say they are less serious? One out of every 4 women is stuck in the iceberg underwater, going unnoticed but continuing to push their bodies in sport beyond what it is physically able to handle. Eventually, these physical symptoms will paramount as fatigue and slowed times or injury and dropping out of the sport; this will challenge her athletic identity, leading to a life saying "I could have been good but I kept getting injured"; transitioning into body image concerns and diet cycling in her 20's as she is unable to exercise like she once was; and the struggle to get pregnant in her 30s due to decisions that impacted her health over a decade ago. My point: diagnosed eating disorder or not, her eating struggles seriously, and negatively, impacted the course of her life though physical and psychological struggle.

In a survey of athletic trainers working with female collegiate athletes, only 27% felt confident identifying an athlete with an eating disorder. Despite this, 91% of athletic trainers reported dealing with an athlete with an eating disorder.

Greenleaf, C., Petrie, T. A., Carter, J., & Reel, J. J. (2009). Female Collegiate Athletes: Prevalence of Eating Disorders and Disordered Eating Behaviors. Journal of American College Health, 57(5), 489-496. doi:10.3200/jach.57.5.489-496

This statistic right here is why I think it's so important to continue the discussion of eating disorders, disordered eating behaviors, body image dysmorphia, adequate fueling, and anti-diet mindsets for athletes. There simply isn't enough help, and we need to bring attention to the gaps in care. In addition to the actual hands-on help needed at the collegiate level, the mindset and behaviors that predict disordered eating behaviors often start in teenage years, so discussions as early as the middle-school or high school level are needed:

In a large study of 14– and 15-year-olds, dieting was the most important predictor of a developing eating disorder. Those who dieted moderately were 5x more likely to develop an eating disorder, and those who practiced extreme restriction were 18x more likely to develop an eating disorder than those who did not diet.

Golden, N. H., Schneider, M., & Wood, C. (2016). Preventing Obesity and Eating Disorders in Adolescents. Pediatrics, 138(3). doi:10.1542/peds.2016-1649

62.3% of teenage girls and 28.8% of teenage boys report trying to lose weight.
58.6% of girls and 28.2% of boys are actively dieting.
68.4% of girls and 51% of boys exercise with the goal of losing weight or to avoid gaining weight.

The National Center on Addiction and Substance Abuse (CASA) at Columbia University. Food for Thought: Substance Abuse and Eating Disorders. The National Center on Addiction and Substance Abuse (CASA) Columbia University; New York: 2003.

That's right, the majority of high school-ers have reported dieting to lose weight and going on a diet as a teenager is the most predictive factor for developing an eating disorder.

In summary.... Teens should NOT diet. Teens should NOT focus on weight loss.

This is why Rise Up Nutrition is passionate about helping youth, high school, and collegiate-age runners. It's such a vital time to develop healthy habits with eating, and to understand the basics of how food fuels the body, without dieting, "clean eating", counting calories, or cutting out food groups. There is a better way to optimize performance and have a winning mindset for life and running.

At the same time, eating disorders do not discriminate. People in their 20's, 30's, 40's, or 50's, any gender, any ethnicity, may have similar eating struggles manifesting in mental stress, abnormal eating behaviors, and physical pitfalls in performance and health. It may have developed at a young age and stuck through the years, or it may have crept up slowly as running became a more prominent part of life. It is never too late to learn how to fuel right and retrain your mind to think about food differently.

Again, the goal of this article is to recognize the prevalence of people struggling with eating, who are NOT at a recovery center, who are NOT diagnosed, but who can and should be hleped non the less.

Please continue to follow Rise Up Nutrition as I will not be silent. I will talk about disordered eating, whether diagnosed eating disorders or something "else" not yet identified. I will speak of them often, and bluntly, because I believe people need to hear the truth. They are NOT shameful, they are NOT sinful, and people with eating disorders are NOT alone. They are very present in the running community. There IS help, there IS a cure, and there IS an end to running in silence and eating alone.

I also strongly support the National Eating Disorder Awareness Association (NEDA) and thank them for statistics quoted in this article: https://www.nationaleatingdisorders.org/

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